Some support for quit-smoking alternatives

NEW YORK (Reuters Health) - Acupuncture and hypnosis are touted as drug-free ways to help smokers kick the habit, and there is some evidence that they work, according to a new research review.

There are still plenty of questions -- including exactly how effective the alternative therapies might be, and how they measure up against standard quit tactics.

But researchers say the alternatives should stand as options for smokers who want them.

The findings, reported in the American Journal of Medicine, come from a review of 14 previous clinical trials.

Six of those studies tested acupuncture against a "sham" version of the procedure (in which, for example, needles were placed in non-acupuncture points on the skin).

Overall, smokers who got real acupuncture were more than three times as likely to be tobacco-free six months to a year later.

Similarly, across four trials of hypnosis, smokers had a higher quit rate with the therapy compared to people who had minimal help -- like an educational booklet on kicking the habit.

In general, smokers who want to quit should first try the standard approaches -- which include nicotine-replacement therapy, medications and behavioral counseling, according to Dr. Mehdi Tahiri of McGill University in Montreal, Canada, who led the review.

"But some people are not interested in medication," he noted in an interview. And in many other cases, the standard quit therapies do not work.

"Then I think we should definitely recommend (acupuncture and hypnosis) as choices," Tahiri said.

But there are caveats.

For their analysis, Tahiri said, the researchers tried to select clinical trials that were conducted in similar ways, to get the most reliable results. But the results of the individual trials did differ.

The benefits linked to acupuncture, for example, were largely based on one 2008 study that tested a few sessions of laser acupuncture in 258 smokers. After six months, 55 percent of smokers who'd received real acupuncture were tobacco-free, versus only four percent of those who'd been given sham acupuncture.

In contrast, a 2007 study from Taiwan looked at needle acupuncture around the ear (the area typically targeted for smoking cessation). Six months later, nine percent of the real-acupuncture group had quit, as had six percent of the sham-acupuncture group.

The situation was similar across the hypnosis trials. Two studies showed big effects: 40 to 45 percent of hypnosis patients were smoke-free six months to a year later. The other two trials showed smaller effects.

Nonetheless, Tahiri said, there was a "trend" toward a benefit across all of the studies of acupuncture and hypnosis.

There are still "definitely questions," he added, about how many sessions of acupuncture or hypnosis might be necessary, or which specific techniques (needle or laser acupuncture, for example) are best.

Other research reviews have concluded that the jury is still out on alternative therapies for quitting smoking.

The Cochrane Collaboration, an international organization that evaluates medical research, recently released reports on hypnosis and acupuncture for smoking cessation (http://bit.ly/ka8fip). In both cases, the group said there's not enough evidence the "complementary" therapies work.

The Cochrane reviewers did not dismiss the alternative approaches -- saying, rather, they may well be better than nothing.

In the real world outside of studies, other issues come up. Depending on where people live, they may not be able to find hypnotherapy or acupuncture designed for smoking cessation.

Tahiri suggested that smokers ask their doctors for referrals to any local therapists. And with acupuncture, he noted, you want to go with a reputable center that uses sterile equipment.

Then there are the costs -- which may range from $400 to $1,000, Tahiri's team points out in its report.

On the other hand, Tahiri said, "the benefits of quitting are tremendous," and smokers should keep trying to find a way that works for them.

The American Lung Association (ALA) says that although some smokers can successfully quit "cold turkey," the best bet for most is to try a combination of medication and some type of behavioral counseling.

Medication can mean either over-the-counter nicotine-replacement therapy products or the prescription drugs varenicline (Chantix) or bupropion (Zyban and generics).

Some recent trials have suggested that about 25 percent of smokers can be cigarette-free at the one-year mark if they get counseling combined with medication.

Even with combination therapies, kicking the smoking habit is often an uphill battle. The ALA estimates that it takes the average smoker five or six serious attempts to finally quit.